Provider Demographics
NPI:1982622593
Name:MONAHAN, CLARK V (DC)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:V
Last Name:MONAHAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 ANASTASIA BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-4508
Mailing Address - Country:US
Mailing Address - Phone:904-824-8353
Mailing Address - Fax:904-824-5705
Practice Address - Street 1:419 ANASTASIA BLVD.
Practice Address - Street 2:
Practice Address - City:ST. AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4508
Practice Address - Country:US
Practice Address - Phone:904-824-8353
Practice Address - Fax:904-824-5705
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH002385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050018600Medicaid
FL89830OtherBLUE CROSS & BLUE SHIELD
FL89830OtherBLUE CROSS & BLUE SHIELD
FLT56358Medicare UPIN